Personal Statement

My experience is coupled with genuine concern for my patients. All of my staff is dedicated to your comfort and prompt attention as well....more

My experience is coupled with genuine concern for my patients. All of my staff is dedicated to your comfort and prompt attention as well.

More about Dr. Piyush Sharma

Dr. Piyush Sharma is a trusted Urologist in Derawal Nagar, Delhi. You can visit him at R G Stone OPD Clinic in Derawal Nagar, Delhi. Book an appointment online with Dr. Piyush Sharma and consult privately on Lybrate.com.

Lybrate.com has an excellent community of Urologists in India. You will find Urologists with more than 39 years of experience on Lybrate.com. You can find Urologists online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

Many people are hesitant to see a doctor for incontinence as they feel embarrassed or believe it can't be treated or that the problem will eventually go away by itself. This may be true in a few cases, but many cases can be successfully treated or managed. The treatment of incontinence will vary according to whether it is faecal or urinary incontinence and will depend on the cause, type and severity of the problem.

Non-medical treatment can be very effective in motivated patients with minor degrees of stress incontinence. The short-term results are often very good, but this isn't always maintained in the long term. Published studies quote cure/improvement rates of 50-80% for pelvic-floor exercises.

Medical treatment

• Oestrogens • Alpha-agonist • Combination of the above

Medical treatment doesn't have a great role in stress incontinence. Postmenopausal atrophy affects the closure of the urethra. Oestrogens, which can be taken orally or applied locally, restores the bulk of urethral tissue leading to more effective closure. Alpha-agonist s increase the tone in the bladder neck, thereby increasing outflow resistance. Some studies indicate a beneficial effect using a combination of oestrogen and an alpha-agonist in older post-menopausal women.

Periurethral injections involve the injection of bulking agents into the urethra to improve effective urethral closure. Commonly used agents include fat, collagen, Teflon paste and silicon particles. Injection therapy is suitable for women with intrinsic sphincter deficiency rather than hyper mobility, as well as for men with post-prostatectomy incontinence. The major advantage of injection therapy is that it's a minor procedure. Short-term results are good, but often not maintained long-term.

The various suspension operations restore the normal anatomy in patients with hyper mobility and improve the support of the urethra and the bladder neck. Open suspension operations like the Burch copo suspension provide the best long-term results. The various needle suspensions have fallen into disuse due to high failure rates.

Urethral slings can be used in people with intrinsic sphincter deficiency as well as those with hyper mobility. It involves the placement of a strip of tissue or artificial substance that supports the urethra and bladder neck like a hammock. It increases outflow resistance and improves urethral closure by supporting the mid urethra. The vast majority of patients can be rendered dry in this way, but the operation does carry the risk of difficulty with passing urine afterwards. Other complications include infection or erosion of the synthetic sling material which then has to be removed.

An artificial urinary sphincter (AUS) made of silicone can be used in someone with total incontinence resulting from irreparable damage to the sphincter. The AUS consists of a small cuff that is placed around the urethra (bladder tube), with a reservoir (balloon) that is placed in the lower belly next to the bladder. Both of these are connected with a small tube to a valve placed in the scrotum, which the person then uses to inflate or deflate the cuff. An AUS is very effective, but it is quite expensive, and there is a risk of infection or erosion of the synthetic material.

2. Urge incontinence

Non-medical treatment

• Bladder training • Biofeedback • Pelvic floor exercises

Voiding by the clock and progressively increasing the time between voids can improve the symptoms of patients with urge incontinence and otherwise normal bladders. This can be combined with biofeedback and pelvic floor exercises.

Medical treatment

• Oxybutynin • Tolterodine • Imipramine

Drug therapy forms the mainstay of treatment for patients with urge incontinence due to bladder instability. These anti cholinergic agents relax the bladder muscle and increase bladder capacity. Side effects include a dry mouth, constipation and blurred vision.

Surgical treatment

Injection of botulinum A toxin (Botox) into the bladder muscle (detrusor) can be used if the urge incontinence is due to a neurological disease causing overactive bladder contractions.

Tiny bladders due to radiation or tuberculosis can be enlarged surgically. A segment of intestine is patched onto the opened bladder, thereby increasing the capacity. Patients with intractable bladder instability who have failed medical treatment can also be treated in this way.

3. Overflow incontinence

Overflow incontinence due to bladder outflow obstruction is treated by surgically alleviating the obstruction. The most common example would be a man with prostatic enlargement treated by resection of the prostate gland. If the incontinence is due to failure of the bladder to contract then intermittent clean self-catheterisation is the most appropriate treatment. Permanent indwelling catheters should be avoided if at all possible.

4. Total incontinence

Total incontinence due to a vesico vaginal fistula or auretero vaginal fistula is treated by surgical repair of the defect.

Treating faecal incontinence

Once your doctor has established the underlying cause of faecal incontinence, they will decide on the most suitable treatment, which could involve a combination of medication, exercise and other methods.

Let’s look at some of the treatment options available for FI:

Dietary changes: If your FI is caused by diarrhoea or constipation, making changes to your diet may sometimes help to normalize and regulate bowel movements. Your doctor may ask you to keep a food diary to monitor the impact of dietary changes. For example, he or she may suggest increasing your intake of high-fibre foods and fluids, or to eliminate foods that may exacerbate the problem.

Medications: Your doctor may recommend specific medication or bulking agents such as fibre supplements to change stool consistency, depending on whether you suffer from diarrhoea or constipation. Another option is Solesta, an injectable FDA-approved gel that's injected into the anus and effectively reduces or completely treats FI in some people. This gel narrows the anal opening by increasing the growth of rectal tissue and helping it to remain tightly closed.

Bowel retraining: This routine encourages normal bowel movements and helps you achieve greater control by becoming more aware of the need to use the toilet. It may incorporate various aspects such as making a conscious effort to have a bowel movement at a specific time of day and using suppositories to stimulate bowel movements.

Biofeedback: This improves the strength and coordination of the anal muscles that help control bowel movements, and heightens the sensation related to the rectum filling with stool. It usually involves a specially trained physiotherapist teaching you simple exercises to strengthen your pelvic-floor muscles, sense when stool is ready to be released and contract the muscles if it's not appropriate to have a bowel movement at a specific time.

Kegel exercises: Also called pelvic-floor exercises, these focus on strengthening the muscles of the anus, buttocks and pelvis. When done correctly, they can be effective in improving or resolving FI. They involve a routine of repeatedly contracting muscles used when making a bowel movement. Hold these muscles as if you're trying to stop the flow of stool or passing gas for a slow count of five, and then relax. Kegel exercises should be done in a series of 30 contractions three times a day. They usually strengthen the pelvic-floor muscles within a few weeks.

Surgery: In some cases, surgery may help people with severe FI who haven't responded to other treatments or people with an underlying condition causing incontinence that need surgery to regain control. There are various surgical options and your doctor will probably refer you to a specialist.

Lemon juice is vitamin C-rich juice and may even dissolve kidney stones, yet studies remains inconclusive on these claims. But, studies does agree that lemon juice may support kidney health but on the other end lemon juice is by no means a cure all for kidney stones. Regardless of this, lemon juice has potent nutritional benefits for the kidneys, possibly providing protection against kidney stone development. But many factors come into play here; however, lemon juice may still be a beneficial addition to the diet of anyone wanting to remove kidneystones----------------For this we may first get to Type of Kidney Stones before we fully investigate the benefits of lemon juice on stone development. The main contributors to kidney stones include:-----------------
1.Cystine — Often the result of a genetic disorder.----------
2.Struvite — Typically develop after a kidney infection.-------------
3.Uric Acid — Typically result from overconsuming meat, fish, and shellfish — generally rare.----------------
4.Calcium Oxalate — Buildup of calcium deposits in the kidneys — most common.------
Calcium is a necessary mineral for the bones, teeth, heart, and nervous system. When the body has excess calcium, the kidneys respond by removing it from the blood and excreting it out through the urine. The problem arises when the body also has excess oxalate, a plant compound found in foods like spinach and kale. This combination can form calcium oxalate, the most common form of kidney stones.----------------------Lemon juice contains high levels of citric acid, not to be confused with ascorbic acid (vitamin C). While lemon juice contains both, citric acid seems to contribute to reducing the chances of developing calcium oxalate stones. In clinical studies, citric acid from lemon juice has been shown to reduce urine acidity, thereby reducing kidney stone incidence. Vitamin C may also provide protection, yet it is unclear whether or not this protection is as significant as citric acid. Regardless, the bottom line is that lemon juice offers a complementary approach to supporting kidney function and, depending on the type of stones in question, possibly halting formation before it starts.-------------------------------150-200 Ml of lemon juice offers plenty of citric acid and a variety of other nutrients and antioxidants, all of which may be helpful for supporting kidney health. Always consume lemon juice in its raw, natural form and never purchase bottled lemon juice, as these products are usually pasteurized and stripped of their raw enzymes and vital nutrients----You can mix it with hot water and some raw honey, or make your own lemonade by combining fresh lemon juice with cold water. ------------------------------------------

Urine infection is the general term used for infection any where in the urinary tract, clinically called as urinary tract infection (uti). Depending upon the location and symptoms diagnosis is done. Uti calls for a treatment with antibiotic medicines, not following which, it will affect the kidneys in the longer run. So the best thing to do is, consult a qualified physician and start the treatment for the duration doctor advises you. Drinks lots of water maintain hygiene.

Fellowship of the Royal College of Surgeons (FRCS), MS - Urology, MBBS

Urologist

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Dear ,
cardinal principle of treatment before or after surgery is avoid constipation at all costs. Yes you can take enema and also take sitz bath: sit in a tubful of warm water for 15 minutes may be twice a day.

Respected lybrate-user hi it may be perianal excoriation of infection don't be stressed. Avoid all oily spicy nonveg stuffs at all have more liquids, fibers, fruits, curd for better digestion. Take sitz bath (sitting in a tub filled with leuk warm water for 10-10 min mor.

Pus in urine is not the good sign. You may suffering from uti. Please take antibiotics and alkskizer to cure uti. Otherwise it will affect you in infertility treatment. Drink more n more water.
Avoid spicy n fried food.

Causes of kidney stones are
* urinary infections * intake of less quantity of fluids & water
* high intake of non vegetarian diets like eggs, red meat, fish.
* high intake of calcium rich diet like milk tomatoes, spinach.
* hormonal disorders (hyperparathyroidism)
in hydronephrosis, urine backflows in kidneys & that causes the damage to kidneys & impairs kidney functions. It may also lead to kidney failure.

If your urine stream is flowing out unsplit and without any feeling of obstruction then you may be having inflammation in your urethral passage inside the penis. You should get your urine examined for evidence of infection and depending upon reports, should consult further on lybrate. Urethritis if continues or occurs repeatedly may cause strictures in urethra and produce obstruction to flow which may need operative procedures for dilatation.

If this is the first episode of urine infection, then you don't need to worry much, in the form of protection, etc. If its happening repeatedly, you need evaluation in the form of partner evaluation (whether he is the source), presence of constipation, diabetes, etc. In that case you need to take care of what is called" post-coital prophylaxis" that is care after sexual intercourse, like local wash, urination, and antibiotics in severe cases.

Fellowship of the Royal College of Surgeons (FRCS), MS - Urology, MBBS

Urologist

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Dear
you are nearing prostatic age so we must consider it. For that get urine examination and sonography with full bladder volume, bladder wall thickness and post-void residual urine volume. Post the results of these tests here with pictures

You better go for a complete medical health check-up in order to rule out any physical problems like diabetes, then only we will be able to come to a conclusion that there may be any psychiatric issues.